Calling All Men: Prostate Cancer Facts, Myths and Guidelines

04232007001_78655744By James L. Mohler, MD

Prostate cancer is among the slowest-growth types of all cancers that we know, and only about ten percent are actually fast-growing types of cancer.

The biggest thing that people need to understand is that all men, as they age, will develop prostate cancer. In fact, your chance of having prostate cancer is about the same as your age – so by the time a man reaches 100 years of age, he has essentially a 100% chance of getting prostate cancer. Therefore, an autopsy performed very carefully will find prostate cancer in many men. This type of very slow-growing, or “autopsy type” cancer rarely causes significant problems since only 1 in 40 American men die of prostate cancer. The challenge for physicians and patients is to find the aggressive prostate cancers that need to be treated.

By the time many men presented with prostate cancer in the old days it was already incurable. But men can now receive a Prostate-Specific Antigen Test or PSA, which was developed right here in Buffalo in the 1970s by T. Ming Chu, PhD, DSc, Chair Emeritus of Diagnostic Immunology Research at Roswell Park Cancer Institute, and his team. The PSA test was approved by the Federal Drug Administration in 1986 for monitoring prostate cancer, and in 1992 for early detection of prostate cancer. The good news is that the death rate from prostate cancer has fallen 40% since 1992.

The PSA test is widely accepted; in the United States alone it is estimated that twenty million PSA tests are run each year, and perhaps a total of one billion tests have been performed worldwide. The bad news is that PSA is not perfect.
A dilemma for physicians and patients is that two-thirds of men with an abnormal PSA don’t have prostate cancer. Many men have an elevated PSA because of an enlarged prostate. This may mean they simply have “autopsy-type” cancer, one not likely to be threatening. So if we treat everyone in whom we can diagnose prostate cancer, we are over-treating people.

We know the public is confused. While most men who have had prostate cancer diagnosed want to be treated, they likely are being treated for “autopsy-type” cancer. Unfortunately, there is no reliable test to determine whether a cancer is the aggressive fast growing or the slow growing type. As a result, we tend to treat men who are younger and healthy, and observe men who are older and in poor health. Men older than 75 are ordinarily watched, while those who are less than 60 are usually treated. The gray zone is in those men between 60 and 75, who usually receive treatment, but probably are better off to consider at least a period of observation. Decisions about getting a PSA and prostate cancer treatment are difficult. These decisions can be made after you get educated and comfortable because prostate cancer grows so slowly.

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About the author:
James Mohler, M.D. is Associate Director and Senior Vice President for Translational Research and Chair of the Department of Urology at Roswell Park Cancer Institute. He is also Chair of the National Comprehensive Cancer Network (NCCN) Guidelines Panel for Prostate Cancer.